Preventive behaviors and behavioral risk factors among gynecologic cancer survivors: Results from the 2020 Behavioral Risk Factor Surveillance System Survey.

BACKGROUND: Maintaining a healthy lifestyle is an important factor in promoting positive outcomes for gynecologic cancer survivors. METHODS: We examined preventive behaviors among gynecologic cancer survivors (n = 1824) and persons without a history of cancer in a cross-sectional analysis, using data from the 2020 Behavioral Risk Factor Surveillance System survey (BRFSS). BRFSS is a cross-sectional telephone-based survey of U.S. residents 18 years of age and older, which collects information about health-related factors and use of preventive services. RESULTS: The prevalence rates of colorectal cancer screening were respectively 7.9 (95% CI: 4.0-11.9) and 15.0 (95% CI: 4.0-11.9) %-points higher among gynecologic and other cancer survivors compared to that of 65.2% among those without any history of cancer. However, no differences were observed in breast cancer screening between gynecologic cancer survivors (78.5%) and respondents without any history of cancer (78.7%). Coverage of influenza vaccination among gynecologic cancer survivors were 4.0 (95% CI: 0.3-7.6) %-points higher than that of the no cancer group, but 11.6 (95% CI: 7.6-15.6) %-points lower than that of the other cancer group. Pneumonia vaccination rate among gynecologic cancer survivors, however, was not statistically different than that of other cancer survivors and respondents with no history of cancer. When examining modifiable risk behaviors, the prevalence of smoking among gynecologic cancer survivors was 12.8 (95% CI: 9.5-16.0) and 14.2 (95% CI: 10.8-17.7) %-points higher than smoking prevalence among other cancer survivors and respondents without any history of cancer. The rate differentials were even higher in rural areas, 17.4 (95% CI: 7.2-27.6) and 18.4 (95% CI: 7.4-29.4) %-points respectively. There were no differences in the prevalence of heavy drinking across the groups. Lastly, gynecologic and other cancer survivors were less likely to be physically active (Δ = -12.3, 95% CI: -15.8 to -8.8 and Δ = -6.9, 95% CI: -8.5 to -5.3, respectively) than those without any history of cancer. CONCLUSION: Smoking prevalence among gynecologic cancer survivors is alarmingly high. Intervention studies are needed to identify effective ways to assist gynecologic cancer survivors to quit smoking and refrain from hazardous alcohol consumption. In addition, women with gynecologic malignancies should made aware of the importance of physical activity.

Implementing a self-monitoring application during pregnancy and postpartum for rural and underserved women: A qualitative needs assessment study.

BACKGROUND: Georgia has one of the highest maternal mortality rates within the US. This study describes the qualitative needs assessment undertaken to understand the needs of rural and underserved women and their perspectives on implementing a self monitoring application during pregnancy and postpartum. METHODS: Qualitative methodology was used to conduct the needs assessment of 12 health care providers (nurses, nurse-midwives, patient care coordinators, and physicians) and 25 women from rural and underserved populations in Georgia was conducted to ascertain common themes on three topics: pregnancy care experiences, comfort with technology, and initial perspectives on the proposed VidaRPM application. Transcription, coding, and consensus were conducted using content analysis and a Cohen's Kappa coefficient was calculated to identify level of overall agreement between raters for the representative quotes identified for each theme. RESULTS: The overall agreement for the representative quotes that were chosen for each theme was in strong agreement (κ = 0.832). The major provider feedback included the following regarding the VidaRPM app: inclusion of questions to monitor physical well-being, embedded valid and reliable educational resources, and multiple modalities. The overall feedback from the mothers regarding the VidaRPM application was the virtual aspect helped overcome the barriers to accessing care, comfort with both WiFi and technology, and sustainable utility. DISCUSSION: The needs of rural and underserved pregnant women and their providers were assessed to develop and refine the VidaRPM app. This qualitative study on the VidaRPM app is the first step towards closing the gap between providers and patients during prenatal and postpartum periods by empowering and educating women into the first-year postpartum living in rural and underserved areas.

A Health Survey of African American Men Seen at an Academic Medical Center in the Southern United States.

BACKGROUND: African Americans have poorer cardiovascular health and higher chronic disease mortality than non-Hispanic whites. The high burden of chronic diseases among African Americans is a primary cause of disparities in life expectancy between African Americans and whites. METHODS: We conducted a cross-sectional study via a postal survey among a sample of 65 male, African American patients aged ≥ 40 years. The overall objective was to examine the frequency of high blood pressure, high cholesterol, diabetes, myocardial infarction, congestive heart failure, stroke, asthma, emphysema, and cancer among patients treated at Augusta University Health. RESULTS: A high percentage of study participants (81.5 %) reported a history of high blood pressure; 50.8% had high cholesterol; 44.3% were overweight, 44.3% were obese, and 13.9% were current cigarette smokers. About 36.9% of the men had a reported history of diabetes; 10.8% of the men had a history of heart attack, 13.9% had a history of congestive heart failure, 9.2% had a history of stroke, and 15.4% had a history of prostate cancer. Men who reported a personal history of prostate cancer were significantly more likely to have a history of heart attack and stroke and to be overweight (p < 0.05 in each instance). DISCUSSION: Additional studies are needed of cardiovascular risk factors and adverse cardiovascular events among African American men, and interventional research aimed at controlling hypertension. Of particular concern is prostate cancer, and whether patients with hypertension, hypercholesterolemia, and diabetes are receiving appropriate therapy to reduce their cardiovascular risk and prevent morbidity and mortality from adverse cardiovascular events.

Faith-Based Pregnancy Center Education Bridges the Maternal Health Gap.

ABSTRACT: Routine prenatal care in the United States has not been effective in reducing maternal mortality and preterm birth rates, nor addressing disparities among non-Hispanic Black women. Pregnant women from minority groups are more likely to be of low socioeconomic status and uninsured, and lacking resources to obtain preconception and early prenatal care to manage medical conditions. Faith-based pregnancy resource centers can help to fill the gap in maternal health among vulnerable populations. This article presents the development of an evidence-based prenatal education and social support program developed for those working in pregnancy resource centers to address disparities and improve outcomes in maternal mortality and preterm birth.

Prevalence and Prevention of Reproducibility Deficiencies in Life Sciences Research: Large-Scale Meta-Analyses.

BACKGROUND Studies have found that many published life sciences research results are irreproducible. Our goal was to provide comprehensive risk estimates of familiar reproducibility deficiencies to support quality improvement in research. MATERIAL AND METHODS Reports included were peer-reviewed, published between 1980 and 2016, and presented frequency data of basic biomedical research deficiencies. Manual and electronic literature searches were performed in seven bibliographic databases. For deficiency concepts with at least four frequency studies and with a sample size of at least 15 units in each, a meta-analysis was performed. RESULTS Overall, 68 publications met our inclusion criteria. The study identified several major groups of research quality defects: study design, cell lines, statistical analysis, and reporting. In the study design group of 3 deficiencies, missing power calculation was the most frequent (82.3% [95% Confidence Interval (CI): 69.9-94.6]). Among the 6 cell line deficiencies, mixed contamination was the most frequent (22.4% [95% CI: 10.4-34.3]). Among the 3 statistical analysis deficiencies, the use of chi-square test when expected cells frequency was <5 was the most prevalent (15.7% [95% CI: -3.2-34.7]). In the reporting group of 12 deficiencies, failure to state the number of tails was the most frequent (65% [95% CI: 39.3-90.8]). CONCLUSIONS The results of this study could serve as a general reference when consistently measurable sources of deficiencies need to be identified in research quality improvement.

Interprofessional Education in Dental Hygiene: Attitudes, barriers and practices of program faculty.

Purpose: Interprofessional education (IPE) experiences are an essential component in preparing dental hygiene students to participate in future interprofessional (IP) collaborations to support comprehensive patient care. The purpose of this study was to determine the attitudes, barriers and IPE practices in a national sample of dental hygiene faculty.Methods: A 25-item, researcher-designed, electronic survey was sent to 1,800 dental hygiene faculty members to determine attitudes, collaboration and practices involving interprofessional education (IPE). Descriptive statistics, Mann Whitney U and the Kruksal Wallis Test of Independent Samples were used to analyze and compare data.Results: The response rate was 22% (n=449). Results suggest faculty have positive attitudes toward IPE and most faculty (73%) incorporated IPE in their programs; however, time constraints were reported as the greatest barrier to IPE participation. A majority (85%) of respondents indicated a desire for greater emphasis on IPE in the curricula. Ethics (37%) was ranked as the most important IPE competency and teamwork the least (19%). Respondents from bachelor's degree programs were more likely to agree that learning with students in other health professions helps students become more effective members of a healthcare team than those from associate's degree programs (p = 0.025). Additionally, respondents from bachelor's degree programs were less likely to agree that clinical problem solving can only be learned when students are taught within their individual schools than those from associate degree programs (p = 0.022).Conclusion: Most of the dental hygiene faculty surveyed considered IPE important, incorporated it into student experiences, and wanted greater curricular emphasis on IPE. Time and institutional support may limit expansion of IPE activities and more collaboration amongst program faculty may be needed.

Are university rankings useful to improve research? A systematic review.

INTRODUCTION: Concerns about reproducibility and impact of research urge improvement initiatives. Current university ranking systems evaluate and compare universities on measures of academic and research performance. Although often useful for marketing purposes, the value of ranking systems when examining quality and outcomes is unclear. The purpose of this study was to evaluate usefulness of ranking systems and identify opportunities to support research quality and performance improvement. METHODS: A systematic review of university ranking systems was conducted to investigate research performance and academic quality measures. Eligibility requirements included: inclusion of at least 100 doctoral granting institutions, be currently produced on an ongoing basis and include both global and US universities, publish rank calculation methodology in English and independently calculate ranks. Ranking systems must also include some measures of research outcomes. Indicators were abstracted and contrasted with basic quality improvement requirements. Exploration of aggregation methods, validity of research and academic quality indicators, and suitability for quality improvement within ranking systems were also conducted. RESULTS: A total of 24 ranking systems were identified and 13 eligible ranking systems were evaluated. Six of the 13 rankings are 100% focused on research performance. For those reporting weighting, 76% of the total ranks are attributed to research indicators, with 24% attributed to academic or teaching quality. Seven systems rely on reputation surveys and/or faculty and alumni awards. Rankings influence academic choice yet research performance measures are the most weighted indicators. There are no generally accepted academic quality indicators in ranking systems. DISCUSSION: No single ranking system provides a comprehensive evaluation of research and academic quality. Utilizing a combined approach of the Leiden, Thomson Reuters Most Innovative Universities, and the SCImago ranking systems may provide institutions with a more effective feedback for research improvement. Rankings which extensively rely on subjective reputation and "luxury" indicators, such as award winning faculty or alumni who are high ranking executives, are not well suited for academic or research performance improvement initiatives. Future efforts should better explore measurement of the university research performance through comprehensive and standardized indicators. This paper could serve as a general literature citation when one or more of university ranking systems are used in efforts to improve academic prominence and research performance.

Respiratory therapy faculty perspectives on interprofessional education: Findings from a cross-sectional online survey.

Interprofessional education (IPE) improves collaboration and patient care through joint education between health professions. Respiratory therapy (RT) has not been previously evaluated as participants in IPE. A cross-sectional online survey was distributed to evaluate the opportunities and barriers towards IPE of 874 respiratory therapy faculty with both quantitative measures and open-ended questions. Responses (n = 187) to open-ended questions about the opportunities and barriers to IPE inclusion included only one significant difference between Associate's (n = 121, 64.7%) and Bachelor's faculty (n = 66, 35.3%). Open-ended questions were analyzed using directed content analysis. Two trained independent reviewers examined responses for common categories. Reviewers then collated initial categories into broader categories. Faculty responses indicate the importance of IPE, barriers related to schedule and faculty attitudes, and perceived opportunities for IPE with nursing programs and through increasing simulation training opportunities. The most common barriers identified were faculty attitudes, scheduling and logistics, curriculum requirements, administration, and time. All faculty seemed to perceive similar opportunities and barriers regardless of programme type and are supportive of IPE inclusion within their curriculums.

Respiratory Therapy Faculty Knowledge of and Attitudes Toward Interprofessional Education.

BACKGROUND: Interprofessional education (IPE) improves collaboration and patient care through joint education between health professions. Respiratory therapy (RT) faculty were surveyed to evaluate their knowledge and attitudes toward IPE. We report current opportunities for IPE from faculty and compare responses from associate's, bachelor's, and master's degree programs and profit versus nonprofit institutions. METHODS: We developed an online survey based on IPE literature and questions modified for the RT discipline. The survey was distributed by email to 874 faculty from the Commission on Accreditation for Respiratory Care accredited programs. RESULTS: The response rate was 33%. Faculty identified IPE as an important component of RT education (n = 207, 80%) but reported challenges in integrating IPE into current curriculum. Overall, communication was ranked as the most important IPE competency (n = 104, 39%) and ethics least important (n = 131, 49%). When asked how many credit hours are required to teach IPE, 48% of respondents reported that they were unsure of an appropriate time requirement. Significant differences between associate's and bachelor's/master's degree program faculty were found on the following topics: institutional resources needed for IPE (P < .001), faculty availability (P < .001), curriculum availability for IPE (P = .02), and importance of including IPE at academic health center campuses (P < .001). CONCLUSIONS: IPE is recognized as an important component of RT education by all faculty respondents. However, significant differences in knowledge and attitudes toward IPE exist between faculty in associate's versus bachelor's/master's degree programs. Revisiting the current accreditation standards program may allow IPE to take a more prominent role in RT curricula.

Micro- and macro-level correlates of adiposity in children.

CONTEXT: Recently, studies using a social ecological perspective have identified important micro- and macro-level risk factors for excessive adiposity in youth. Although considerable research exists examining these relationships, few studies have applied a socioecological approach to simultaneously examine both micro- and macro-level factors in young children while objectively assessing adiposity via dual-energy x-ray absorptiometry (DXA). OBJECTIVE: To examine race and sex differences in adiposity measured by DXA in a large sample of young children and to identify both micro- and macro-level correlates of adiposity. DESIGN: Cross-sectional. SETTING AND PARTICIPANTS: Elementary school children (N = 495) from the southeastern United States participated. Anthropometrics, percentage body fat via DXA, and psychosocial variables via questionnaire were assessed in the Fall of 2003. Community-level sociodemographic data and built-environment variables via geographic information system were collected in Spring 2009. Data analyses were completed in the Spring of 2010. RESULTS: Percentage body fat in white children was higher than in nonwhite children. Higher percentage body fat and poorer cardiovascular fitness were found in females compared with males. Percentage body fat was higher in children who had lower athletic competence and lived in neighborhoods with higher percentages of minority residents. CONCLUSION: This study provides preliminary support for the social-ecological model to explain variance in adiposity in children. Developers of health promotion programs for children living in minority neighborhoods should consider factors at multiple levels of the ecological model when designing and implementing programs.

The impact of a 3-year after-school obesity prevention program in elementary school children.

BACKGROUND: Children tend to be sedentary during the after-school hours, and this has deleterious effects on their health. The objective of the present study was to determine the effects of a 3-year after-school physical activity (PA) program, without restriction of dietary energy intake, on percent body fat (%BF), cardiorespiratory fitness (CRF), and cardiometabolic markers in children. METHODS: A cluster randomization design was employed. A total of 574 3rd grade children from 18 elementary schools in the southeastern United States participated. The intervention consisted of 80 minutes of age-appropriate moderate-to-vigorous PA each school day. The main outcomes of interest were %BF measured by dual-energy X-ray absorptiometry; CRF measured by heart rate in response to a submaximal step test; nonfasting total and high-density lipoprotein cholesterol (HDL-C); and resting blood pressure (BP). RESULTS: Intent-to-treat analyses showed significant treatment by time interactions for %BF (p = 0.009) and CRF (p = 0.0003). The change pattern of the means suggested that %BF and CRF in intervention children improved relative to control children during the school months, rebounding to the levels of control children over the summers following years 1 and 2. Year-by-year analyses of what occurred during the months when the program was offered revealed dose­response relations for %BF and CRF, such that the clearest beneficial effects were seen for those youth who attended at least 60% of the after-school sessions. No significant intervention effects were seen for cholesterol or BP. CONCLUSIONS: An after-school PA program was effective in reducing adiposity and improving CRF, especially in the children who attended the sessions at least 3 days/week. However, the favorable effects on %BF and CRF were lost over the summer. Thus, it is critical to incorporate strategies that attract and retain the children to receive an adequate dose of PA year-round.

Maternal stress, physical activity, and body mass index during new mothers' first year postpartum.

We evaluated associations of parenting stress, including depressive symptoms, with 51 first-time mothers' light and moderate physical activity and body mass index during the first year postpartum. The Parenting Stress Index and 24-hour physical activity recalls were completed during the first year postpartum (mean time elapsed since birth: 6 months). Direct relationships between identified variables were tested, and then hierarchical linear regression was used to assess hypothesized relationships among body mass index, physical activity, and parenting stress. Effects of parenting stress on the relationships between postpartum body mass index, light physical activity, and moderate physical activity were evaluated after controlling for factors known to be associated with overweight and low levels of physical activity in women. Mean postpartum body mass index = 27.4 kg/m² ± 7.7, range = 18-50 kg/m². Mean reported hours of light physical activity = 11.2 ± 3.0, and moderate physical activity = 4.5 ± 3.0 per day. Postpartum body mass index was not associated with parenting stress, but was positively related to higher pre-pregnancy body mass index (r = .89, p < .01) and light physical activity (r = .32, p < .05), and was negatively related to moderate physical activity (r = -25, p < .08). Higher postpartum body mass index (ß = .27, p < .05), less concern regarding parenting competence (ß = -.95, p < .001), and more depressive symptoms (ß = .66, p < .01) were associated with more light physical activity (R² = .48, p < .001). More moderate physical activity (R² = .45, p < .001) was associated with lower postpartum body mass index (ß = -.27, p < .05), more concern about parenting competence (ß = 1.0, p < .001), and less depressive symptoms (ß = -.68, p < .01). Higher postpartum body mass index (R² = .89, p < .001) was associated with higher pre-pregnancy body mass index (ß = .99, p < .001), more pregnancy weight gain (ß = .22, p < .001), less attachment (ß = -.68, p < .01), and less social isolation (ß = -.13, p < .02). These data suggest that interventions that target parenting stress and depressive symptoms in addition to physical activity are needed to prevent development of overweight in new mothers.